Rachel Castor, a single mom of two and teacher, stands outside her home in Sandpoint, Idaho. Castor’s son could not be admitted to the local hospital during an asthma attack because Bonner General Health lost its pediatrician coverage at the same time it closed the labor and delivery unit in 2023 following the Dobbs decision. (Photo by Erick Doxey for States Newsroom)

Editor’s note: This report examines the impact of the U.S. Supreme Court decision that struck down the federal right to abortion three years ago.

Of all the outcomes Rachel Castor could have predicted from Idaho’s abortion ban, her teenage son being denied hospital admission during an asthma attack wasn’t on the list.

Bonner General Hospital in Sandpoint announced its decision to end obstetric services in March 2023, roughly six months after the near-total ban took effect. Among the stated reasons were the state’s legal and political climates concerning health care, and the loss of pediatrician staffing.

Castor saw the fallout from that decision on a night in early April. Her 17-year-old son spent several hours in the Bonner General emergency room, before the staff informed her if his breathing didn’t improve enough for discharge by the morning, he would need to be transferred an hour south to the hospital in Coeur d’Alene. Bonner General had no pediatricians.

“And I was like, ‘Excuse me?’” Castor said.

Elaine Gloeckle, a 66-year-old Boise resident, said she started having trouble with urinary tract infections and hormonal balances recently and found it hard to get an appointment to see a specialist, even with a referral. It was even more difficult to see a doctor for gynecological care. That wasn’t always the case in the more than 30 years she’s lived in the area — she used to have no trouble seeing doctors.

But now for the gynecology visits, along with care for diabetes management and kidney issues, she has seen physician assistants, who are supervised by the doctors within a practice. While she has had good experiences with the assistants, it’s sometimes difficult to feel confident in their assessments when she isn’t sure how much they are consulting with doctors. And the wait times are still long — at least six weeks, usually, in her experience.

“I have no idea who the doctors are, I’ve never met them,” Gloeckle said. “And I don’t know if that means anything, or if it’s just peace of mind that there is a doctor in the mix.”

It’s been three years since the U.S. Supreme Court issued the Dobbs ruling that ended federal abortion protections and allowed more than a dozen states to implement abortion bans. States that were already struggling with physician shortages say they’re getting worse, especially in rural areas, where many labor and delivery units have also closed their doors. Clinics have closed and resources become more strained with every passing year.

Patients and providers have been left to adjust to barriers accessing abortion care; legal battles that continually redraw access lines; and heartbreak and tragedy as women die from easily treatable conditions like miscarriage and infection.

In places like Florida, Kansas and Louisiana, patients have had to find other providers who will help them with miscarriage complications, often requiring them to travel to a neighboring state with legal access because doctors in states with bans are afraid to see them. Other patients experiencing miscarriage or the threat of miscarriage have reported waiting hours in emergency rooms to be seen while hospital staff consult with attorneys about their legal exposure before taking any action. A Florida Republican lawmaker who opposes abortion said recently that she waited hours to receive treatment for an ectopic pregnancy, which is dangerous and nonviable.

Besides Texas, few states that implemented abortion bans after Dobbs have been as much of a spectacle as Idaho. Between a so-called “abortion trafficking” law that first passed in Idaho, the very public loss of many OB-GYNs and maternal-fetal medicine specialists, and a legal fight with the federal government over whether abortions should be permitted in emergencies — a lawsuit that made its way before the U.S. Supreme Court — the state has been a testing ground of sorts for how a near-total abortion ban can play out for communities.

Many health care providers and advocates warned it wouldn’t just be abortion care, or even pregnancy-related care, that would be affected by the Dobbs decision. Dr. Stacy Seyb, a maternal-fetal medicine specialist in Boise, said in July 2023 that the near-total ban would lead to more consequences as time went on.

“It feels like a step backward in improving the health of women and children in the state,” he told The Guardian. Soon, he warned, the state would “see a collapse in women’s health care.”

‘It makes me wonder what else we’ve lost that we don’t know about’

Bonner General Health’s obstetrics unit was one of many rural hospitals that was already struggling before Dobbs with changing community demographics that meant lower birth rates and difficulty recruiting and retaining physicians. Among its population of about 10,000, the hospital admitted fewer than 10 pediatric patients in 2022 and delivered 265 babies, a decrease from prior years.

It’s a familiar situation nationwide. More than 100 hospitals across 26 states have closed labor and delivery services since 2020. To be sure, the reasons for those closures include many more factors than abortion bans, such as low reimbursement rates from Medicaid programs for obstetrical services and difficulty recruiting and retaining physicians.

In its announcement, Bonner General representatives said they tried to recruit active and retired pediatrics providers in the area, but no long-term sustainable solutions were available.

At that time, it didn’t sink in for Castor that having no pediatrician coverage at the hospital would mean no admission to the hospital for minor children.

Sandy Brower, director of quality and risk management at Bonner General Health, told States Newsroom via email that their staff is well-equipped to see pediatrics patients, who are always seen, treated and stabilized in the emergency department. But she confirmed that the hospital does not admit minors because they have no pediatricians on staff.   

“This approach is not unusual in rural health care,” Brower said. “Around the country, critical access hospitals often rely on stabilization and transfer protocols to ensure that patients …  are seen in the most appropriate setting.”

Faced with the prospect of driving her son to Coeur d’Alene herself or guessing what a 44-mile ambulance ride might cost, Castor — a single mom of two and a teacher — decided to drive to the hospital she’d never been to before. But with little information to go on about the transfer process, she was left wandering around the hospital looking for the right place to go while her son’s condition deteriorated.

“He’d already been away from the hospital for an hour for the drive, and he was starting to not do OK, and it was really stressful because I didn’t know what we were supposed to do,” Castor said. “He had his arms wrapped around himself and he just didn’t look good.”

Once she found her way, Castor said everything went well and they were discharged after one more night. But she was left shaken by the experience and her sense of stability about where she lives. She shares custody with a former partner who lives nearby, so it’s difficult to consider moving.

“I think everyone at the hospital is lovely, but it does seem like we don’t have all the services we need,” Castor said. “It makes me wonder what else we’ve lost that we don’t know about.”

Physician recruitment difficult for pediatrics in populous areas too

Amid the implementation of the abortion ban, Idaho’s population exploded. Between 2020 and 2024, more than 152,000 people moved in and the total number crossed 2 million statewide for the first time in its history. On top of all that, at least three clinics that provided labor and delivery services closed, including two in the Boise area, the most populous portion of the state. The combination created longer wait times and more complicated staffing scenarios.

Christine Myron, spokesperson for Idaho’s largest health care system St. Luke’s, told States Newsroom via email that the time to get an appointment with an OB-GYN has increased over the last two years in all of their service areas, which include every region of the state.

Myron also said in recent weeks, a candidate for a pediatrician position declined their offer because of the restrictive obstetrical care environment in Idaho. She said the difficulties in recruiting extend to every specialty of physicians because young families hesitate to move in.

As of Wednesday, St. Luke’s had 10 pediatric physician vacancies, including specialists for pediatric nephrology, oncology, infectious disease and endocrinology. 

Shifting providers, delays frustrating while trying to conceive

For women like Cynthia Dalsing, who has lived in Sandpoint for more than 30 years, it’s difficult because of her age and location. She is 71, and a recent exam showed a polyp in her uterus that needed to be biopsied and removed. That type of exam and procedure could have been done 3 miles away from her house a few years ago, she said, before Bonner General closed its labor and delivery services.

Instead, she drove back and forth to Coeur d’Alene to complete pre-operative steps, including X-rays, blood work and an EKG, then to have the procedure, then to go back again to talk about the results.

“It’s taken weeks to get care that normally would be pretty routine,” Dalsing said. “It’s a 20-minute procedure.”

The procedure was dilation and curettage, Dalsing said, often referred to as a D&C, which is the same treatment sometimes used for an early abortion or miscarriage where pregnancy tissue needs to be removed from the uterus. When she mentioned the upcoming appointment to a friend, Dalsing said they asked if that was still allowed, given the abortion ban, not knowing it’s a common procedure for many other conditions.

“That’s how clueless and confused people are about all this,” Dalsing said. 

Younger women like 36-year-old Danielle Young, who has lived in Boise since the early 2000s, report issues receiving care as well. Young said since 2016, she has switched providers five times because they kept leaving — three of those were within the past three years.

Young said she had to wait eight months for an annual gynecological wellness appointment with a nurse practitioner, and when the time came, the exam felt rushed and chaotic. After that, she decided to switch practices. Young said it took another six months to be seen by the doctor she chose, but it has been worth the wait.

At the same time, Young said she and her husband are trying to conceive, and he has had difficulties finding a clinic where he can get fertility testing. She said most of the past year has been wasted just trying to reach someone on the phone who can tell them where he should go and when he can get an appointment.

“It’s been frustrating for us, because we would like to have children or a child, and I’m getting older,” Young said.

California is going to war, legally speaking, against the Federal government. On Thursday, the GOP-led Senate voted to strip the state of its longstanding ability to set its own vehicle emissions rules. California’s response? A firm promise to sue the federal government if and when US President Donald Trump signs the measure into law.

More: GM’s Urgent Warning, California’s EV Rules Could Harm You

When the news broke, California Governor Gavin Newsom didn’t wait long to respond. He immediately called the move illegal and said it was harmful to health and the environment. “The party of MAHA (Make America Healthy Again) is making our world smoggier,” he said. To revoke the waiver from California, the Senate did go against counsel from two nonpartisan government entities that both said it would be illegal to do so.

States’ Rights or Regulatory Overreach?

That said, the GOP felt that California had too much power and was leveraging that power to set rules on a pseudo-federal level. Several states had joined California in imposing the same rules, including one that banned new gas-car sales after 2035.

Based on data, those goals were far too lofty considering the current state of EV adoption in the U.S. The GOP decision takes the stress off of automakers, oil companies, and dealers who felt they were going to be stuck with products that wouldn’t sell well.

Health First, Says California

For many in California, the state’s regulations are prioritizing health and wellness above all else. “We have real-world evidence that these rules are improving public health,” said Dr. John Balmes, of UC Berkeley. A recent study from the University of Southern California showed a significant reduction in asthma-related emergency room visits for children and adults associated with the number of electric vehicles in a zip code.”

Others in the state see the revocation of the waiver as a positive move. “I think this was a good middle ground that we can still talk about EVs,” said John Pitre, CEO of Motor City Auto Club in Bakersfield, to BakersfieldNow. “We can still develop them. We can still have future opportunities to explore different types of EVs. But it’s not at the detriment of people having a selection of gas or diesel-powered vehicles that they may really want.”

Ultimately, only time will tell whether or not California’s lawsuit will claw back its freedom to set its own standards. This will be the 21st lawsuit filed by the state attorney general against the Trump administration. “The federal government’s overreach is illogical,” Bonta said in a press conference in Sacramento. “It’s politically motivated, and it comes at the expense of Californians’ lives and livelihoods.”

Credit: Governor Gavin Newsom

In a move that could reshape the future of clean transportation policy in the U.S., Senate Republicans just voted to strip California of its long-standing authority to set its own vehicle emissions rules, including blocking its plan to stop sales of gas-powered vehicles.

The decision targets California’s ambitious clean-air mandates, which critics say are too aggressive for the current market to handle. Supporters of the state’s standards, however, argue that this vote undermines state rights and sets a troubling precedent for federal overreach.

More: Major US Dealers Launch War On New EV Sales Model

California has long set its own rules regarding air pollution standards. These included regulations on heavy-duty trucks, trains, and cars. It had even declared that it wouldn’t allow the sale of gas-powered new cars and trucks after 2035. But that authority was just revoked using the Congressional Review Act, or CRA.

This happened despite warnings from two nonpartisan agencies, the Senate parliamentarian and the Government Accountability Office, both of which warned the Senate that this move was likely illegal. Nevertheless, the Senate voted 51 to 44 to overturn the waiver that grants California the power it had to set its own rules.

A Shift With National Consequences

This is a huge move because California, by itself, equates to the fourth-largest economy on the globe. Automakers have largely followed California’s guidance on emissions to keep selling cars there. Several states have also taken up the same standards. Now, all of that is in question as Donald Trump’s signature will axe the waiver for good.

Reacting to the news, California Governor Gavin Newsom said, “The United States Senate has a choice: cede American car-industry dominance to China and clog the lungs of our children, or follow decades of precedent and uphold the clean air policies that Ronald Reagan and Richard Nixon fought so hard for. Will you side with China or America?”

The Conservative Pushback

Those on the other side of the political aisle obviously have a different view. “California has imposed the most ridiculous car regulations anywhere in the world, with mandates to move to all electric cars,” Trump said during his campaign, reports The Guardian. “I will terminate that.”

“The fact is, these EV sales mandates were never achievable,” John Bozzella, president and chief executive of the Alliance for Automotive Innovation, said in a statement. “There’s a significant gap between the marketplace and these EV sales requirements.”

How did the party of small government justify stepping in and imposing its will on a state this way? It says that since California has such a large sway on the auto industry that it was effectively setting Federal policy all along. This move stops that ability and returns that power to the Federal level alone.

“Over the past two decades, California has used its waiver authority to push its extreme climate policies on the rest of the country, which was never the intent of the Clean Air Act,” Senator Shelley Moore Capito, Republican of West Virginia, said to the New York Times.

The Hard Numbers

As we recently pointed out, data does seem to indicate that California’s goals surrounding the end of gas-powered new car sales are too ambitious. While EVs are gaining traction around the world, the U.S. is one of the slowest markets concerning adoption.

No doubt, that’s the result of several factors like distance between destinations, charging infrastructure, and pricing. Regardless of why the uptake is slower, it still makes California’s goals tough to imagine coming true. This new move from the Senate makes it appear altogether impossible now. 

The path to mainstream electrification is all but inevitable. Despite that, many lawmakers are trying to slow it down. Add to that one of the automakers building thousands of EVs every year, General Motors. A newly uncovered email exposes the company as it urges employees to get political. It hopes that with enough support, the government will stop California from setting its own emission standards.

More: New Bill To Kill EV Tax Credits Will Only Benefit One Brand

The Golden State has long done exactly that. In 2022, it went as far as to tell automakers that they had a little over a decade. By 2035, it won’t allow the sale of new gas-powered cars and trucks. While that would seemingly be good for EV sales, the plan has several critics aside from General Motors.

The Golden State vs. Detroit

“We need your help!” GM said in an email to white-collar employees obtained by The Wall Street Journal. “Emissions standards that are not aligned with market realities pose a serious threat to our business by undermining consumer choice and vehicle affordability.” It’s worth noting that California isn’t alone in its thinking. 11 other states have signed up to follow the same plan. Now, GM and several lawmakers want to remove California’s ability to set its own standards and thus, cancel the ability for the other states involved.

In a statement, GM’s spokeswoman made the company’s stance clear: “GM believes in customer choice, and we continue to focus on offering the best and broadest portfolio of vehicles on the market”. That’s consistent with the automaker’s view, even when it supported California’s proposal in the past. Clearly, a national standard is in the best interest of automakers since they wouldn’t have to manage different regulations in different states.

Government officials say the standards set in California are simply out of touch with reality. Data seems to back that up, too. It set a target to have 35 percent of all vehicle sales be electric in 2026. Right now, EVs only make up 20 percent of new car sales, and that’s in a place where EVs are wildly popular when compared to other states.

EV sales in North America are slower than in most places across the globe. The transition to electrification appears like a sure thing, but probably further down the road than initially expected. 

GM’s interest in hydrogen fuel cell technology may seem like a recent endeavor following their work with Honda, but the American automaker has been tinkering with the stuff since the 1960s. While NASA was busy figuring out how fuel cells could help them conquer the space race, GM was busy figuring out how to make hydrogen work on Earth.

Related: GM’s Electrovair Is The Precursor To The Company’s Electric Future

Batteries of the time didn’t have the beans to power the Apollo command module’s communications, drinking water, lighting, and air conditioning systems, so NASA turned to fuel cells, which turn hydrogen into electricity.

And at the same time, GM, having already created two purely battery-powered EVs in the form of a pair of converted Corvairs, Electrovair I and II, was looking to explore the possibilities for hydrogen power back on Earth.

A Fuel Cell System Too Big for the Job

The fuel cell it created with the help of Union Carbide was so massive there was no way it was going to fit into a Corvair, so GM switched to the Handi-Bus, a passenger version of its Handi-Van and a VW Type 2 bus and Ford E-series rival. Even then, the powertrain’s bulk turned the van into a two-seater.

The system, which combines hydrogen and oxygen in an electrochemical reaction that produces water, heat, and electricity, wasn’t only big due its large hydrogen and oxygen tanks, but heavy, too. A total curb weight of 7,100 lbs (3,220 kg) makes most modern EVs – GMC Hummer EV aside – look like lightweights, and 3,900 lbs (1,770 kg) of that was down to the fuel cell equipment.

Predictably, performance was abysmal, zero to 60 mph (96 km/h) taking around 30 seconds, though to to fair ,a stock Handi-Bus with the base 90 hp (91 PS) 2.5-liter four was no fireball either. GM reckoned the range was around 150 miles (240 km) but never tested that on the public road due to safety concerns that turned out to be well-founded. During one test an external fuel tank exploded, shooting debris a quarter mile (400 m) away.

A Test Project, Not a Production Vehicle

This was a true test-bed project and GM never intended to put the Electrovan into production. But it showed that a fuel-cell vehicle could work and paved the way for more efficient, more compact successors that get their oxygen from the air rather than from space-eating tanks of compressed oxygen.

Almost 60 years later, GM is still committed to both BEV and fuel-cell technology, particularly believing that its Hydrotec fuel cell cubes makes more sense in big commercial vehicles like Komatus’s mining trucks than batteries, which are better suited to lighter passenger cars, trucks and SUVs.

Americans bought 1.3 million fully-electric cars, trucks and SUVs in 2024 and tax credits of up to $7,500 on new EVs was one of the major factors driving take-up. But those credits might to be around much longer judging by comments made by a senior Republican.

“I think there is a better chance we kill it than save it,” House Speaker Mike Johnson said of the tax credit system in an interview with Bloomberg this week. “But we’ll see how it comes out.”

Related: IRS Lets EV Buyers Claim Missed Tax Credits Retroactively

It’s been no secret that the new Trump administration is not a big fan of the credits, which were introduced during Barack Obama’s time in office and have undergone changes during Joe Biden’s era governing which EVs and which buyers are eligible. Other countries, including the UK and Germany, have already scrapped subsidies, believing EV demand is now strong enough for the segment to survive without them (sales are up in the UK, down in Germany).

Axing the credits would fit in with Trump’s policies of promoting fossil fuels and dismantling green initiatives started during the four years before his second stint at the White House began. And dropping credits would also help Republicans meet their target of saving $2 trillion from government spending, though it’s real impact would be almost imperceptible considering ‘only’ $2 billion was spent on EV subsidies in the first 10 months of last year.

The impact of canning the credits on US carmakers and customer demand for EVs, however, could be very significant. Electric cars are currently more expensive to make than gas cars and credits help bring the retail price closer to ICE money, though not all battery vehicles are eligible.

Take-up of EVs was already slower in the US in 2024 than it had been in 2023 and without the credit sweetener buyers might choose to buy a combustion car instead at a time when US-based automakers have invested billions in developing electric cars and batteries, and in some cases creating entirely new plants in which to build them.

Those points may help save the incentives because some Republican lawmakers might be unwilling to vote for something that could lead to job losses in their region, while others are already in favor of safeguarding some existing green initiatives.